Clinical study of local injection of autologous platelet-rich plasma in treatment of diabetic foot ulcer_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

QIN Xinyuan ,  WANG Jiangning

Department of Orthopaedic Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, P.R.China;

Corresponding author：

WANG Jiangning, Email: dlwangjn@vip.sina.com

Keywords：

Platelet-rich plasma; diabetic foot; ulcer; local injection; wound repair

DOI：

10.7507/1002-1892.201905124

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Objective To investigate the effectiveness of local injection of autologous platelet-rich plasma (PRP) in treatment of diabetic foot ulcer.Methods Between October 2017 and October 2018, 90 diabetic foot ulcer patients who met the selection criteria were randomly divided into 3 groups: PRP injection group (group A, PRP was injected and hydrogel dressing covered the wounds), PRP covered group (group B, PRP gel and hydrogel dressing covered the wounds), and the control group (group C, hydrogel dressing covered the wounds), 30 cases in each group. There was no significant difference in gender, age, injured side, disease duration, preoperative glycosylated hemoglobin, wound size, and Wagner grading between groups (P>0.05). The frequency of treatments and hospitalization day in all groups and the total amount of PRP application in groups A and B were recorded. The wound healing condition was recorded during the treatment, and the wound healing rate was calculated at 3 months after the first debridement.Results The frequency of treatments in groups A, B, and C were (10.2±0.8), (11.4±0.6), (12.5±0.5) times, respectively. The total amount of PRP application of groups A and B were (306±24) and (342±18) mL, respectively. There was no significant difference in the frequency of treatments and the total amount of PRP application between groups (P>0.05). The hospitalization days of groups A, B, and C were (40.5±1.8), (62.1±2.3), and (88.6±1.4) days, respectively, showing significant differences between groups (P<0.05). In the course of treatment, the necrosis and exudation of the wounds gradually reduced, the areas of wounds gradually reduced; and the above conditions of group A were significantly better than groups B and C, and group B was better than group C. At 3 months after the first debridement, the wound healing rates of groups A, B, and C were 93.2%±0.8%, 52.1%±1.1%, and 21.3%±1.3%, respectively, with significant differences between groups (P<0.05).Conclusion PRP can effectively promote the repair of diabetic foot ulcer. The effectiveness of local injection of PRP is superior to the local coverage.

Citation： QIN Xinyuan, WANG Jiangning. Clinical study of local injection of autologous platelet-rich plasma in treatment of diabetic foot ulcer. Chinese Journal of Reparative and Reconstructive Surgery, 2019, 33(12): 1547-1551. doi: 10.7507/1002-1892.201905124 Copy

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2.	Kim CH, Moon JS, Chung SM, et al. The changes of trends in the diagnosis and treatment of diabetic foot ulcer over a 10-year period: single center study. Diabetes Metab J, 2018, 42(4): 308-319.
3.	World Health Organisation. The top 10 causes of death. World Health Organisation. http://www.who.int/media-centre/factsheets/fs310/en/.
4.	Zhang P, Lu J, Jing Y, et al. Global epidemiology of diabetic foot ulceration: a systematic review and meta-analysis. Ann Med, 2017, 49(2): 106-116.
5.	Geraghty T, LaPorta G. Current health and economic burden of chronic diabetic osteomyelitis. Expert Rev Pharmacoecon Outcomes Res, 2019, 19(3): 279-286.
6.	Hurlow JJ, Humphreys GJ, Bowling FL, et al. Diabetic foot infection: a critical complication. Int Wound J, 2018, 15(5): 814-821.
7.	Riaz M, Miyan Z, Waris N, et al. Impact of multidisciplinary foot care team on outcome of diabetic foot ulcer in term of lower extremity amputation at a tertiary care unit in Karachi, Pakistan. Int Wound J, 2019, 16(3): 768-772.
8.	Kılıçoğlu ÖI, Demirel M, Aktaş Ş. New trends in the orthopaedic management of diabetic foot. EFORT Open Rev, 2018, 3(5): 269-277.
9.	Armstrong DG, Boulton AJM, Bus SA. Diabetic foot ulcers and their recurrence. N Engl J Med, 2017, 376(24): 2367-2375.
10.	Shin JY, Roh SG, Lee NH, et al. Influence of epidemiologic and patient behavior-related predictors on amputation rates in diabetic patients: systematic review and meta-analysis. Int J Low Extrem Wounds, 2017, 16(1): 14-22.
11.	van Netten JJ, Baba M, Lazzarini PA. Epidemiology of diabetic foot disease and diabetes-related lower-extremity amputation in Australia: a systematic review protocol. Syst Rev, 2017, 6(1): 101.
12.	Jansen RB, Jørgensen B, Holstein PE, et al. Mortality and complications after treatment of acute diabetic Charcot foot. J Diabetes Complications, 2018, 32(12): 1141-1147.
13.	Raghav A, Khan ZA, Labala RK, et al. Financial burden of diabetic foot ulcers to world: a progressive topic to discuss always. Ther Adv Endocrinol Metab, 2018, 9(1): 29-31.
14.	Georgescu DE, Mustăţea P, Mihalache O, et al. Surgical management of diabetic neuropathy foot complications. Chirurgia (Bucur), 2018, 113(5): 634-643.
15.	Astasio-Picado Á, Mart EE, Martín BG. Comparison of thermal foot maps between diabetic patients with neuropathic, vascular, neurovascular, and no complications. Curr Diabetes Rev, 2019. [Epub ahead of print].
16.	Whitman DH, Berry RL, Green DM. Platelet gel: an autologous alternative to fibrin glue with applications in oral and maxillofacial surgery. J Oral Maxillofac Surg, 1997, 55(11): 1294-1299.
17.	Kim SJ, Kim EK, Kim SJ, et al. Effects of bone marrow aspirate concentrate and platelet-rich plasma on patients with partial tear of the rotator cuff tendon. J Orthop Surg Res, 2018, 13(1): 1.
18.	Xing D, Wang Q, Yang Z, et al. Mesenchymal stem cells injections for knee osteoarthritis: a systematic overview. Rheumatol Int, 2018, 38(8): 1399-1411.
19.	Smith RG. Validation of Wagner’s classification: a literature review. Ostomy Wound Manage, 2003, 49(1): 54-62.
20.	Lamboo M, Poland DC, Eikenboom JC, et al. Coagulation parameters of thawed fresh-frozen plasma during storage at different temperatures. Transfus Med, 2007, 17(3): 182-186.
21.	de Leon JM, Driver VR, Fylling CP, et al. The clinical relevance of treating chronic wounds with an enhanced near-physiological concentration of platelet-rich plasma gel. Adv Skin Wound Care, 2011, 24(8): 357-368.
22.	韩莉, 伊力哈木江·依马木. 糖尿病足病发病机制及诊疗现况. 医学综述, 2014, 20(7): 1259-1261.
23.	Amable PR, Carias RB, Teixeira MV, et al. Platelet-rich plasma preparation for regenerative medicine: optimization and quantification of cytokines and growth factors. Stem Cell Res Ther, 2013, 4(3): 67.
24.	Anitua E, Orive G. Endogenous regenerative technology using plasma and platelet-derived growth factors. J Control Release, 2012, 157(3): 317-320.
25.	孙妍娜, 张荣明, 毛旭, 等. 复合脂肪来源干细胞的脱细胞异种神经联合富血小板血浆修复兔面神经损伤的实验研究. 中国修复重建外科杂志, 2018, 32(6): 736-744.
26.	纪庆明, 杨育晖, 于庆巍, 等. 富血小板血浆辅助前交叉韧带重建治疗的临床疗效分析. 中国修复重建外科杂志, 2017, 31(4): 410-416.
27.	Kang YH, Jeon SH, Park JY, et al. Platelet-rich fibrin is a Bioscaffold and reservoir of growth factors for tissue regeneration. Tissue Eng Part A, 2011, 17(3-4): 349-359.
28.	Mazzucco L, Borzini P, Gope R. Platelet-derived factors involved in tissue repair-from signal to function. Transfus Med Rev, 2010, 24(3): 218-234.
29.	Singla S, Singla S, Kumar A, et al. Role of epidermal growth factor in healing of diabetic foot ulcers. Indian J Surg, 2012, 74(6): 451-455.
30.	Souza TF, Andrade AL, Ferreira GT, et al. Healing and expression of growth factors (TGF-β and PDGF) in canine radial ostectomy gap containing platelet-rich plasma. Vet Comp Orthop Traumatol, 2012, 25(6): 445-452.
31.	Ruszkowska-Ciastek B, Sokup A, Socha MW, et al. A preliminary evaluation of VEGF-A, VEGFR1 and VEGFR2 in patients with well-controlled type 2 diabetes mellitus. J Zhejiang Univ Sci B, 2014, 15(6): 575-581.
32.	Kim HJ, Yeom JS, Koh YG, et al. Anti-inflammatory effect of platelet-rich plasma on nucleus pulposus cells with response of TNF-α and IL-1. J Orthop Res, 2014, 32(4): 551-556.
33.	Li H, Li B. PRP as a new approach to prevent infection: preparation and in vitro antimicrobial properties of PRP. J Vis Exp, 2013, (74): 50351.
34.	Deppermann C, Kubes P. Platelets and infection. Semin Immunol, 2016, 28(6): 536-545.
35.	Giraldo CE, Álvarez ME, Carmona JU. Influence of calcium salts and bovine thrombin on growth factor release from equine platelet-rich gel supernatants. Vet Comp Orthop Traumatol, 2017, 30(1): 1-7.
36.	Aggour RL, Gamil L. Antimicrobial effects of platelet-rich plasma against selected oral and periodontal pathogens. Pol J Microbiol, 2017, 66(1): 31-37.

1. International Diabetes Federation. IDF Diabetes Atlas. 8th ed. Brussels: International Diabetes Federation, 2017.
2. Kim CH, Moon JS, Chung SM, et al. The changes of trends in the diagnosis and treatment of diabetic foot ulcer over a 10-year period: single center study. Diabetes Metab J, 2018, 42(4): 308-319.
3. World Health Organisation. The top 10 causes of death. World Health Organisation. http://www.who.int/media-centre/factsheets/fs310/en/.
4. Zhang P, Lu J, Jing Y, et al. Global epidemiology of diabetic foot ulceration: a systematic review and meta-analysis. Ann Med, 2017, 49(2): 106-116.
5. Geraghty T, LaPorta G. Current health and economic burden of chronic diabetic osteomyelitis. Expert Rev Pharmacoecon Outcomes Res, 2019, 19(3): 279-286.
6. Hurlow JJ, Humphreys GJ, Bowling FL, et al. Diabetic foot infection: a critical complication. Int Wound J, 2018, 15(5): 814-821.
7. Riaz M, Miyan Z, Waris N, et al. Impact of multidisciplinary foot care team on outcome of diabetic foot ulcer in term of lower extremity amputation at a tertiary care unit in Karachi, Pakistan. Int Wound J, 2019, 16(3): 768-772.
8. Kılıçoğlu ÖI, Demirel M, Aktaş Ş. New trends in the orthopaedic management of diabetic foot. EFORT Open Rev, 2018, 3(5): 269-277.
9. Armstrong DG, Boulton AJM, Bus SA. Diabetic foot ulcers and their recurrence. N Engl J Med, 2017, 376(24): 2367-2375.
10. Shin JY, Roh SG, Lee NH, et al. Influence of epidemiologic and patient behavior-related predictors on amputation rates in diabetic patients: systematic review and meta-analysis. Int J Low Extrem Wounds, 2017, 16(1): 14-22.
11. van Netten JJ, Baba M, Lazzarini PA. Epidemiology of diabetic foot disease and diabetes-related lower-extremity amputation in Australia: a systematic review protocol. Syst Rev, 2017, 6(1): 101.
12. Jansen RB, Jørgensen B, Holstein PE, et al. Mortality and complications after treatment of acute diabetic Charcot foot. J Diabetes Complications, 2018, 32(12): 1141-1147.
13. Raghav A, Khan ZA, Labala RK, et al. Financial burden of diabetic foot ulcers to world: a progressive topic to discuss always. Ther Adv Endocrinol Metab, 2018, 9(1): 29-31.
14. Georgescu DE, Mustăţea P, Mihalache O, et al. Surgical management of diabetic neuropathy foot complications. Chirurgia (Bucur), 2018, 113(5): 634-643.
15. Astasio-Picado Á, Mart EE, Martín BG. Comparison of thermal foot maps between diabetic patients with neuropathic, vascular, neurovascular, and no complications. Curr Diabetes Rev, 2019. [Epub ahead of print].
16. Whitman DH, Berry RL, Green DM. Platelet gel: an autologous alternative to fibrin glue with applications in oral and maxillofacial surgery. J Oral Maxillofac Surg, 1997, 55(11): 1294-1299.
17. Kim SJ, Kim EK, Kim SJ, et al. Effects of bone marrow aspirate concentrate and platelet-rich plasma on patients with partial tear of the rotator cuff tendon. J Orthop Surg Res, 2018, 13(1): 1.
18. Xing D, Wang Q, Yang Z, et al. Mesenchymal stem cells injections for knee osteoarthritis: a systematic overview. Rheumatol Int, 2018, 38(8): 1399-1411.
19. Smith RG. Validation of Wagner’s classification: a literature review. Ostomy Wound Manage, 2003, 49(1): 54-62.
20. Lamboo M, Poland DC, Eikenboom JC, et al. Coagulation parameters of thawed fresh-frozen plasma during storage at different temperatures. Transfus Med, 2007, 17(3): 182-186.
21. de Leon JM, Driver VR, Fylling CP, et al. The clinical relevance of treating chronic wounds with an enhanced near-physiological concentration of platelet-rich plasma gel. Adv Skin Wound Care, 2011, 24(8): 357-368.
22. 韩莉, 伊力哈木江·依马木. 糖尿病足病发病机制及诊疗现况. 医学综述, 2014, 20(7): 1259-1261.
23. Amable PR, Carias RB, Teixeira MV, et al. Platelet-rich plasma preparation for regenerative medicine: optimization and quantification of cytokines and growth factors. Stem Cell Res Ther, 2013, 4(3): 67.
24. Anitua E, Orive G. Endogenous regenerative technology using plasma and platelet-derived growth factors. J Control Release, 2012, 157(3): 317-320.
25. 孙妍娜, 张荣明, 毛旭, 等. 复合脂肪来源干细胞的脱细胞异种神经联合富血小板血浆修复兔面神经损伤的实验研究. 中国修复重建外科杂志, 2018, 32(6): 736-744.
26. 纪庆明, 杨育晖, 于庆巍, 等. 富血小板血浆辅助前交叉韧带重建治疗的临床疗效分析. 中国修复重建外科杂志, 2017, 31(4): 410-416.
27. Kang YH, Jeon SH, Park JY, et al. Platelet-rich fibrin is a Bioscaffold and reservoir of growth factors for tissue regeneration. Tissue Eng Part A, 2011, 17(3-4): 349-359.
28. Mazzucco L, Borzini P, Gope R. Platelet-derived factors involved in tissue repair-from signal to function. Transfus Med Rev, 2010, 24(3): 218-234.
29. Singla S, Singla S, Kumar A, et al. Role of epidermal growth factor in healing of diabetic foot ulcers. Indian J Surg, 2012, 74(6): 451-455.
30. Souza TF, Andrade AL, Ferreira GT, et al. Healing and expression of growth factors (TGF-β and PDGF) in canine radial ostectomy gap containing platelet-rich plasma. Vet Comp Orthop Traumatol, 2012, 25(6): 445-452.
31. Ruszkowska-Ciastek B, Sokup A, Socha MW, et al. A preliminary evaluation of VEGF-A, VEGFR1 and VEGFR2 in patients with well-controlled type 2 diabetes mellitus. J Zhejiang Univ Sci B, 2014, 15(6): 575-581.
32. Kim HJ, Yeom JS, Koh YG, et al. Anti-inflammatory effect of platelet-rich plasma on nucleus pulposus cells with response of TNF-α and IL-1. J Orthop Res, 2014, 32(4): 551-556.
33. Li H, Li B. PRP as a new approach to prevent infection: preparation and in vitro antimicrobial properties of PRP. J Vis Exp, 2013, (74): 50351.
34. Deppermann C, Kubes P. Platelets and infection. Semin Immunol, 2016, 28(6): 536-545.
35. Giraldo CE, Álvarez ME, Carmona JU. Influence of calcium salts and bovine thrombin on growth factor release from equine platelet-rich gel supernatants. Vet Comp Orthop Traumatol, 2017, 30(1): 1-7.
36. Aggour RL, Gamil L. Antimicrobial effects of platelet-rich plasma against selected oral and periodontal pathogens. Pol J Microbiol, 2017, 66(1): 31-37.

Chinese Journal of Reparative and Reconstructive Surgery

Clinical study of local injection of autologous platelet-rich plasma in treatment of diabetic foot ulcer

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